| NPI | 1689004582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP113431) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX 665918) |
| Enumeration Date | 2013-11-14 |
| Last Update Date | 2023-12-28 |